Its effects are very personal because of how each individual person may perceive it differently even when situations are similar. Stress is the summation of mental and physical result of an undesirable discrepancy between actual versus perceived personal experiences and personal expectancies (Parker, 2007). These stresses manifest themselves differently in every individual. In the health care industry, stresses come in all forms and originate from several different factors. Stress may originate as psychological stress but may eventually manifest with the presentation of physiological signs.
Briefly stated, stress is defined is any challenge to the homeostasis of an individual’s physiological, psychologic, or spiritual well being. Stress in the workplace has become one of the most prevalent pressures affecting adults in today’s society worldwide.
Occupational Stress has become an epidemic of the 21st Century according to the World Health Organization (Borkowski, 2016). Because of the major global changes in industrial and economic changes, the 1990s can be considered a time that occupational stress became an area of major concern (Dunham, 2001).
When assessing the cost of stress in a workplace, one must not only consider the financial costs related to absenteeism, presenteeism, turnovers, and work acquired injuries. Other costs that should be accounted for may be deemed medical in nature because they describe the physiological issues that present within an individual as a result of prolonged stress. Those issues could include but are not limited to depression, anxiety, cardiovascular disease, musculoskeletal disorders, and diabetes (Frogeli, Rudman, & Gustavsson, 2018).
It can be assumed that stress would not such an important source of discussion in the health care workplace however, the deficiency that seems to ruminate is the lack of individual’s abilities to cope with these stressors.
This ultimately is the reason for the manifestation of the psychosocial, physical and psychological conditions mentioned by Frogeli and colleagues. Within this paper, several subjects will be addressed to discuss the topic of stress and its affect on workers in a health care organization.
The basics about stress will be discussed to explain the different types of stress that exist. By identifying these, one may be able to discern the progression of stress. Over the years, several conjectures have been presented in relation to work related stress and how it develops. In understanding these theories, managers and other organizational heads may derive strategies to reduce stress in their organization. Based upon the theories presented by the writer, examples will be provided to remediate the primary stressors that exist in health care organizations. Many times, when discussing stress within a workplace, one may assume that the stress employees experience exists solely as a result of dysfunction within the organization only.
However, after reviewing this paper, the reader may better understand how personal experiences outside of the workplace may also affect stresses for individuals working in the health care field. Types of Stress Acute Stress According to the American Psychological Association (APA), acute stress is the most prevalent type of stress and is recognizable by most people (APA, 2011). Although acute stress stimulates an instantaneous fight or flight response, it isn’t always bad stress. This type of stress may present in health care when a large number of patients are sent to a hospital’s emergency department at one time or when preparing to present to colleagues. Although acute stress is short lived, it can present with somatic responses such as tensions headaches, gastric issues, muscular tension, jaw clenching, anxiety, and irritability.
Left unrecognized and unaddressed, acute stress may progress to chronic stress or, subsequently, post traumatic stress disorder (PTSD) (Kaufer et al, 1998). In the health care setting, this may be seen with those involved in direct patient care such as your physicians, nurses, nurse’s assistants, and therapists. This form of stress may be the impetus for these health care professionals to provide effective and efficient care to their patients. However, without appropriate coping strategies, they may affect their personal lives.
Episodic Acute Stress is similar to acute stress because it tends to have a quick onset, however, these stressful situations tend to happen at a high frequency. Essentially, individuals that experience episodic acute stress tend to have lifestyles that are full of chaos, crisis, and pessimism (APA, 2011). Individuals that are said to have “Type A” personalities tend to experience this particular form of stress most frequently. This is because the very thing that makes them great makes them stressed. These individuals are highly competitive, highly education, goal-oriented, and hardworking.
Two cardiologist, Drs. Friedman and Rosenham, discovered this personality type impose stress on themselves because of higher expectations of themselves. These individuals are more prone to high blood pressures and hear attacks (Jenkins, Zyzanski & Rosenman, 1971). As a health care provider, especially in a direct patient care position, you will experience this type of stress frequently which may be a major deficiency because it tends to come with acute cardiac events.
Chronic Stress Finally, chronic stress is a type of stress that has the longest lasting effects. Chronic stress is the internal or external condition, state, or stimuli of a prolonged sustained threat. These threat that are experienced may be either perceived or real (Ross, Foster, & Ionescu, 2017). When individuals are not capable of coping with exposure to chronic stress, psychiatric illnesses may present. Amongst the most prevalent psychopathologies are depression, anxiety, post traumatic stress disorder, substance use disorder, and personality disorders (Sheth, McGlade & Yurgelun-Todd, 2017).
All of the aforementioned illnesses can prevent a health care provider from doing their job. The most troubling fact about chronic stress is that people get use to it. Chronic stress may require extensive medical and psychological treatments to manage the stress. However, chronic stress can be considered fatal because it is often the precipitating factor to many suicides, heart attacks, strokes, violence against others and the development of cancer when not acknowledged or treated (APA, 2011). According to the National Institute for Occupational Safety and Health (NIOSH), occupational stress is more associated with health issues than financial or family issues (NIOSH, 1999).
Canadian physiologist, Hans Selye, often referenced as the grandfather of stress research, introduced the concept of good stress (Borokowski, 2016).
Good stress is also known as eustress or positive stress. Eustress is the assessment of stressors as chances or trials that the individual feels assured about overcoming by effectively activating and using coping strategies (Kozusznik, Rodriguez & Peiro, 2015). In the workplace, the presence of eustress can facilitate a feeling of job satisfaction to individuals.
When this positive stress exists, workers have a high morale, achieve high work performance, and approach challenges with an expectation of successful completion. Eustress may also facilitate an optimal environment for teamwork. An example of eustress in a health care organization would be the administrative and clinical staff working diligently to open a new outpatient clinic as a satellite location to the community hospital. Conversely, distress exists when an individual believe that stressors pose a threat or may cause harm. This stress is seen as negative stress because it is both overwhelming and poorly manage.
Distress may have behavioral, physiological and psychological effects for individuals when confronted with negative stressors (Borokowski, 2016). According to Dr. Hans Selye, a predictable physiological response to these stressors, known as General Adaptation Syndrome, in stressful situation. The three stages of General Adaptation Syndrome are the alarm phase, the resistance phase, and the exhaustion phase. In the Alarm Phase, the fight or flight response is activated which increases heart rate and blood pressure. The second stage, the Resistance Phase, occurs as the alarm phase is beginning to cease.
At this point, both the blood pressure and heart rate begin to return to normal if the stressor is removed. The final stage that presents as a result of the body continually attempting to recover and failing. In the Exhaustion Stage, the body is no longer capable of fighting the stress. This may result in fatigue, depression, anxiety, and hopelessness. Theories of Work Related Stress Lazarus and Folkman’s Transactional Model of Stress and Coping The Transactional Model of Stress and Coping describes to two responses to stressors.
The first response is how severe the stressor being encountered is perceived to be. This response is a unique account because no two people will have the exact same perspective even when the situations are similar. The second response is how well an individual can manage the stressors as they occur (Lazarus and Folkman, 1987).
An example of this would be an overbooked physician’s ability to develop a strategy and execute it without compromising patient care or getting burned out. Theoretically, if the physician sees this task as feasible, he is capable of managing the stress that comes along with this high stress situation. As a manager, it is important to know the abilities of your employees and make assignments accordingly. When employees feel that they capable of managing the task at hand, they are less likely to experience psychological stress or burnout.
The Effort Reward Imbalance Theory describes a failed relationship of reciprocity between effort and reward. This theory explains negative feelings and continuous stress responses are the result of high effort and low reward. On the other hand, when appropriate reward is issued in response to a specific effort, positive emotions exists, and the person has feelings of well-being and experiences less stress. In a workplace, rewards can be in the form of money, career progression, or professional respect (van Vegchel et al, 2005).
An example of the Effort Reward Imbalance Theory in the healthcare would be a therapist performing the tasks of a scheduler but, receiving no appreciation for the clinic’s owner for going above and beyond what was required of the job for which they were hired. Although the therapist may not have expected a monetary reward, words of affirmation and appreciation may have served as an adequate reward. The therapist may become discouraged and unappreciated which will now make coming to work a source of continuous stress. As a manager, it is important to acknowledge employees and show appreciation for their efforts. While finances may not always allow bonuses, words of appreciation can be just as rewarding.
Fit Theory Organizations are more productive when they hire individuals who have the skill set required for the job, demonstrate loyalty and commitment, and are able to adapt to changes within the job. Employees seek out employers that are capable of utilizing their skill set and meet their personal needs. These concepts are the premise of the Person Environment Fit Theory.
It surmises that a person will tend to do excel and be satisfied in a job that they are better equipped with the skills to perform (Caplan 1987). In a workplace, when an individual feels they are expected to perform a task that they have no knowledge, they may ultimately have feelings of inadequacy.
In essence, an administrator or manager that places their employee in this position is setting them up for failure. Disappointment as a result of this failure in spite of their best effort may cause undue stress on the employee and effect their performance. As a manager, to reduce risk of increased stress due to an incompatibility between a person’s skills and the job demands, it is important to observe a “one man, one job” approach. This will reduce the stress of failure for the employee and the manager. Job Demand Control Support Theory During the 1980s, R. Karasek and his colleagues developed a model that demonstrated a correlation between job demand, job control, and job social support.
The model states that individuals are more prone to poor psychological well being and cardiovascular diseases when their jobs require high demand, low control, and low social support. This is also known as iso-strain (Kristensen, 1995). An example of an individual that would experience stress due to iso-strain would be a single dentist with a large clientele but no one to fill in for him to take a vacation. Because he has no support but, continues to have a responsibility to his clients, he may be more apt more psychological stress. When situations such as this are not remediated, people may experience burnout or job dissatisfaction.
Strategies for Coping with Stress in the Workplace Stress in the workplace is an experience that is inevitable but, can be perceived differently by individuals involved in similar situations. The process of stress management requires a modification of the surrounding and/ or the individual (Borokowski, 2016).
To combat stress in the workplace, individuals may use reactive coping, anticipatory coping, preventative coping, or proactive coping. Reactive coping is a response that occurs after a stressor occurs. An example of this would be a manager dealing with the resignation of an employee. To cope with this situation, the manager would have to reassign the tasks of that employee to others. Anticipatory coping is a stress management strategy aimed at avoiding or minimizing critical events that may pose potential risks in the future (Borsellino & Young, 2011).
An example of anticipatory coping would be a manager ensuring more than one nurse has training in wound care so that coverage would still be available in the absence of the nurse who primarily performs the task. Preventative Coping is a strategy that makes an effort to increase resistance so that the impact of the stressor is perceived as less severe (Borokowski, 2016).